anidulafungin
Pharmacologic class: Semisynthetic echinocandin
Therapeutic class: Antifungal
Pregnancy risk category C
Action
Inhibits glucan synthase, an enzyme present in fungal (but not mammalian) cells; this action inhibits formation of 1,3-beta-D-glucan, an essential component of fungal cell wall.
Availability
Powder for injection (lyophilized): 50-mg single-use vial
Indications and dosages
➣ Candidemia and other Candida infections (intra-abdominal abscess, peritonitis)
Adults: Single 200-mg loading dose by I.V. infusion on day 1, followed by 100 mg I.V. daily thereafter. Duration depends on clinical response; generally, therapy continues at least 14 days after last positive culture.
➣ Esophageal candidiasis
Adults: Single 100-mg loading dose by I.V. infusion on day 1, followed by 50 mg I.V. daily thereafter. Treatment should continue for at least 14 days, and for at least 7 days after symptoms resolve; duration depends on clinical response. Due to risk of esophageal candidiasis relapse in patients with human immunodeficiency virus, suppressive antifungal therapy may be considered after treatment ends.
Contraindications
• Hypersensitivity to drug, its components, or other echinocandins
Precautions
Use cautiously in:
• hepatic impairment
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
Administration
☞ Don't give by I.V. bolus.
• Reconstitute only with supplied diluent (20% dehydrated alcohol in water for injection).
• Further dilute only with 5% dextrose injection or normal saline solution, to yield infusion solution concentration of 0.5 mg/ml.
• Give by I.V. infusion within 24 hours of reconstitution.
☞ Don't infuse at a rate exceeding 1.1 mg/minute.
• Don't dilute with other solutions or infuse through same I.V. line with other drugs or electrolytes.
Adverse reactions
CNS: headache
CV: hypotension, phlebitis
GI: aggravated dyspepsia, nausea, vomiting
Hematologic: neutropenia, leukopenia
Respiratory: dyspnea
Skin: rash, urticaria, pruritus, flushing
Other: fever
Interactions
Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase: increased
Patient monitoring
• If patient has abnormal liver function tests during therapy, monitor for evidence of worsening hepatic function and weigh risks and benefits of continuing therapy.
• Monitor for rash, urticaria, flushing, dyspnea, and hypotension. (However, these are rare when drug is administered slowly.)
Patient teaching
☞ Instruct patient to report rash, itching, unusual bruising or bleeding, unusual tiredness, or yellowing of skin or eyes.
• Advise patient to report troublesome side effects such as GI upset.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the tests mentioned above.